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Proliferative vitreoretinopathy and its relationship with inflammatory serum biomarkers

International Journal of Ophthalmology(English edition) 2024年第9期17卷 1659-1664页

作者： victor Alejandro Martinez Pacheco Sergio Rojas Juarez Braulio Hernan Velasco Sepulveda Abel Ramirez Estudillo Hospital de Nuestra Señora de la Luz Retina and Vitreous DepartmentMexico City 06030Mexico Instituto de Oftlamología FAP conde de Valenciana Mexico City 06080Mexico

AIM:To analyze if a relationship between levels ofinflammatory serum biomarkers and severity of primaryproliferative vitreoretinopathy(PVR)***:A retrospective case-control *** adult patients with rhegmatogenous retinaldetachment and primary PVR were included in the *** the control group,healthy adults who underwentcataract surgery were *** grade of PVR wasclassified according to the Retinal Society *** samples were obtained before surgery,and processed in MYTHIc *** of interest wereneutrophil-to-lymphocyte ratio(NLR),platelet-to-lymphocyteratio(PLR),and lymphocyte-to-monocyte ratio(LMR),thetime between the decrease in visual acuity and surgery,PVRgrade,type of surgery,final best corrected visual acuity,andrate of ***:Totally 240 patients were included,120 ineach group,79(65.8%)and 56(46.7%)were male in thePVR and control group,*** A had greaterlevels of monocytes(0.28±0.18 vs 0.12±0.32,P=0.002),neutrophils(4.59±1.51 vs 3.92±1.27,P=0.006),and LMR(9.32±4.42 vs 7.43±3.90,P=0.01).PVR B had a greatermonocyte count(0.30±0.13 vs 0.12±0.32,P=0.001),andPVR c.demonstrated higher levels in monocytes(0.27±0.12vs 0.12±0.32,P=0.004),neutrophils(4.39±1.13 vs3.92±1.27,P=0.004),and LMR(9.63±3.24 vs 7.43±3.90,P=0.002)compared to control,*** LMR cut-offvalue of 9.38 predicted PVR with a sensibility of 54.2%andspecificity of 77.5%and NLR cut-off of 1.70 predicted PVRwith a sensibility of 62%and specificity of 54.2%.cONcLUSION:Patients with primary PVR demonstrategreater neutrophil,monocyte,and LMR levels than thecontrol ***-off values obtained from ratios could beuseful in a clinical setting when no posterior view of thefundus is possible due to media opacity.

关键词： biomarkers proliferative vitreoretinopathy retinal detachment inflammation serum

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Impact of payment source, referral site, and place of residence on outcomes after allogeneic transplantation in Mexico

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World Journal of Transplantation 2024年第2期14卷 76-87页

作者： Andrés Gómez-de León Yesica A López-Mora Valeria García-Zárate Ana Varela-constantino Sergio U Villegas-de Leon Xitlaly J González-Leal Raúl del Toro-Mijares Anna c Rodríguez-Zúñiga Juan F Barrios-Ruiz victor Mingura-Ledezma Perla R colunga-Pedraza Olga G cantú-Rodríguez césar H Gutiérrez-Aguirre Luz Tarín-Arzaga Elías E González-López David Gómez-Almaguer Hematology Service Universidad Autónoma de Nuevo LeónFacultad de Medicina y Hospital Universitario Dr.JoséEleuterio GonzálezMonterrey 64460Nuevo LeónMexico Hemato-logy Service Clínica Gómez AlmaguerMonterrey 64710Nuevo LeónMexico Hematology Service Instituto Tecnológico de Estudios Superiores de MonterreyTec SaludEscuela de Medicina Ignacio SantosMonterrey 64710Nuevo LeónMexico

BAcKGROUND The impact of social determinants of health in allogeneic transplant recipients in low-and middle-income countries is poorly *** observational study analyzes the impact of place of residence,referring institution,and transplant cost coverage(out-of-pocket vs government-funded vs private insurance)on outcomes after allogeneic hematopoietic stem cell transplantation(alloHScT)in two of Mexico's largest public and private *** To evaluate the impact of social determinants of health and their relationship with outcomes among allogeneic transplant recipients in *** In this retrospective cohort study,we included adolescents and adults≥16 years who received a matched sibling or haploidentical transplant from *** were selected without regard to their diagnosis and were sourced from both a private clinic and a public University Hospital in *** payment groups were compared:Out-of-pocket(OOP),private insurance,and a federal Universal healthcare program“Seguro Popular”.Outcomes were compared between referred and institution-diagnosed patients,and between residents of Nuevo Leon and *** outcomes included overall survival(OS),categorized by residence,referral,and payment *** outcomes encompassed early mortality,event-free-survival,graft-versus-host-relapse-free survival,and non-relapse-mortality(NRM).Statistical analyses employed appropriate tests,Kaplan-Meier method,and cox proportional hazard regression *** software included SPSS and R with tidycmprsk *** Our primary outcome was overall *** included 287 patients,n=164 who lived out of state(57.1%),and n=129 referred from another institution(44.9%).The most frequent payment source was OOP(n=139,48.4%),followed by private insurance(n=75,26.1%)and universal coverage(n=73,25.4%).No differences in OS,event-free-survival,NRM,or graft-versus-host-relapse-free survival were observed for patients dia

关键词： Hematopoietic cell transplant Social determinants of health Geography Haploidentical Out-of-pocket Financial toxicity Survival Health services and outcomes Hematopoietic malignancy Aplastic anemia

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Functional Roux-en-Y Gastric Bypass (F-RYGB), with Preservation of Duodenal Access: Report of Two Revisional cases of Sleeve Gastrectomy

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Surgical Science 2024年第3期15卷 135-158页

作者： victor Ramos Mussa Dib carlos Augusto Scussel Madalosso Paulo Reis Esselin de Melo Rui Ribeiro Paula Volpe carlos Eduardo Domene victor Dib Institute Manaus Brazil Gastrobese clinic Passo Fundo Brazil Paulo Reis Institute of Bariatric Surgery Goi&#226nia Brazil Alfredo Nasser University center (UNIFAN) Goi&#226nia Brazil Lusíadas Amadora Hospital Lisboa Portugal Integrated center for Advanced Medicine (cIMAMED) S&#227o Paulo Brazil

Objective: This case report aimed to demonstrate a possible neuromuscular effect of Latarjet nerves transection or truncal vagotomy, in association with sleeve gastrectomy plus antrojejunostomy, in order to reproduce a Roux-en-Y gastric bypass (RYGB) mechanistic principles, in patients with previous Sleeve Gastrectomy (SG) who had had weight regain, with or without concomitant gastroesophageal reflux disease (GERD). Background: Sleeve gastrectomy (SG) is one of the most frequently performed bariatric operations worldwide. Nevertheless, weight regain and gastroesophageal reflux disease (GERD) have been consistently demonstrated, in association with this technique, which may require a revisional procedure. RYGB is an option in such a situation but, implies in gastrointestinal exclusions, which represents a shortcoming of this revision. Surpassing this inconvenient would be of great value for the patients. Methods: We describe herein two cases of SG revision for weight regain and GERD, with a follow-up of one year. Gastroesophageal reflux disease was evaluated by validated questionnaire, upper endoscopy, seriography, high resolution manometry (HRM) and impedance pHmetry (I-pHmetry), in the pre and postoperative periods. A re-Sleeve Gastrectomy with antrojejunal anastomosis was done in both cases, after informed consents. The Latarjet nerves were transected in one case, due to a bleeding in the left gastric vessels and a truncal vagotomy was required in the other, to appropriately treat an associated hiatal hernia. Results: In the postoperative evaluation it was observed a pyloric spasm in both cases, during seriography and endoscopy, kept until the one-year follow-up. There was unidirectional contrast flow to the gastrointestinal anastomosis, filling the jejunal limb, in radiologic contrast study. No contrast passed through the pylorus. Nonetheless, the duodenum was kept endoscopically accessible. In the one-year evaluation, weight loss was adequate and GERD resolution

关键词： Roux-en-Y Gastric Bypass Sleeve Gastrectomy Jejuno Gastric Bypass Vagus Nerve Vagotomy Bariatric Surgery

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The Effect of Retinoic Acid on Neutrophil Innate Immune Interactions With cutaneous Bacterial Pathogens

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Infectious Microbes & Diseases 2024年第2期6卷 65-73页

作者： Alexandra Stream Ross corriden Simon Döhrmann Richard L.Gallo victor Nizet Ericka L.Anderson Division of Host-Microbe Systems and Therapeutics Department of PediatricsUniversity of California San Diego School of MedicineLa JollaCaliforniaUSA department of dermatology University of California San Diego School of MedicineLa JollaCaliforniaUSA Skaggs School of Pharmacy and Pharmaceutical Sciences University of California San DiegoLa JollaCaliforniaUSA

Vitamin A and its biologically active derivative,retinoic acid(RA),are important for many immune ***,in particular,is essential for the development of immune cells,including neutrophils,which serve as a front-line defense against *** vitamin A deficiency has been linked to higher susceptibility to infections,the precise role of vitamin A/RA in host-pathogen interactions remains poorly ***,we provided evidence that RA boosts neutrophil killing of methicillin-resistant Staphylococcus aureus(MRSA).RA treatment stimulated primary human neutrophils to produce reactive oxygen species,neutrophil extracellular traps and the antimicrobial peptide cathelicidin(LL-37).Because RA treatment was insufficient to reduce MRSA burden in an in vivo murine model of skin infection,we expanded our analysis to other infectious *** did not affect the growth of a number of common bacterial pathogens,including MRSA,Escherichia coli K1 and Pseudomonas aeruginosa;however,RA directly inhibited the growth of group A Streptococcus(GAS).This antimicrobial effect,likely in combination with RA-mediated neutrophil boosting,resulted in substantial GAS killing in neutrophil killing assays conducted in the presence of ***,in a murine model of GAS skin infection,topical RA treatment showed therapeutic potential by reducing both skin lesion size and bacterial *** findings suggest that RA may hold promise as a therapeutic agent against GAS and perhaps other clinically significant human pathogens.

关键词： retinoic acid neutrophil bacterial infection Staphylococcus aureus group A Streptococcus neutrophil extracellular traps antimicrobial peptide cathelicidin

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cerebral and muscle tissue oxygenation during exercise in healthy adults: A systematic review

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Journal of Sport and Health Science 2024年第4期13卷 459-471,F0003页

作者： Diego Orcioli-Silva victor Spiandor Beretta Paulo cezar Rocha Santos Felipe Marroni Rasteiro Anita Brum Marostegan Rodrigo Vitorio claudio Alexandre Gobatto Fulvia Barros Manchado-Gobatto Laboratory of Applied Sport Physiology(LAFAE) School of Applied Sciences(FCA)University of Campinas(UNICAMP)Limeira 13484-350Brazil Posture and Gait Studies Laboratory(LEPLO) Institute of BiosciencesSao Paulo State University(UNESP)Rio Claro 13506-900Brazil Physical Education department School of Technology and SciencesSao Paulo State University(UNESP)Presidente Prudente 19060-900Brazil department of computer Science&Applied Mathematics Weizmann Institute of ScienceRehovot 7610001Israel center of Advanced Technologies in Rehabilitation Sheba Medical CenterRamat Gan 5265601Israel department of Sport Exercise and RehabilitationNorthumbria UniversityNewcastle upon Tyne NE18STUK

Background:Near-infrared spectroscopy(NIRS)technology has allowed for the measurement of cerebral and skeletal muscle oxygenation simultaneously during *** this technology has been growing and is now successfully used in laboratory and sports settings,this systematic review aimed to synthesize the evidence and enhance an integrative understanding of bloodﬂow adjustments and oxygen(O_(2))changes(i.e.,the balance between O_(2) delivery and O_(2) consumption)within the cerebral and muscle systems during ***:A systematic review was conducted using PubMed,Embase,Scopus,and Web of Science databases to search for relevant studies that simultaneously investigated cerebral and muscle hemodynamic changes using the near-infrared spectroscopy system during *** review considered manuscripts written in English and available before February 9,*** step of screening involved evaluation by 2 inde-pendent authors,with disagreements resolved by a third *** Joanna Briggs Institute critical Appraisal checklist was used to assess the methodological quality of the ***:Twenty studies were included,of which 80%had good methodological quality,and involved 290 young or middle-aged *** types of exercises were used to assess cerebral and muscle hemodynamic changes,such as cycling(n=11),treadmill(n=1),knee extension(n=5),isometric contraction of biceps brachii(n=3),and duet swim routines(n=1).The cerebral hemodynamics anal-ysis was focused on the frontal cortex(n=20),while in the muscle,the analysis involved vastus lateralis(n=18),gastrocnemius(n=3),biceps brachii(n=5),deltoid(n=1),and intercostal muscle(n=1).Overall,muscle deoxygenation increases during exercise,reaching a plateau in voluntary exhaustion,while in the brain,oxyhemoglobin concentration increases with exercise intensity,reaching a plateau or declining at the exhaustion ***:Muscle and cerebral oxygenation respond differently to exercise,with muscle

关键词： Near-infrared spectroscopy Hemodynamic Blood flow Brain Muscle metabolism

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Artificial intelligence-driven radiomics study in cancer:the role of feature engineering and modeling

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Military Medical Research 2024年第1期11卷 115-147页

作者： Yuan-Peng Zhang Xin-Yun Zhang Yu-Ting cheng Bing Li Xin-Zhi Teng Jiang Zhang Saikit Lam Ta Zhou Zong-Rui Ma Jia-Bao Sheng victor cWTam Shara WYLee Hong Ge Jing cai department of Medical Informatics Nantong UniversityNantong 226001JiangsuChina department of Health Technology and Informatics the Hong Kong Polytechnic UniversityHong Kong 999077China The Hong Kong Polytechnic University Shenzhen Research Institute Shenzhen 518000GuangdongChina department of Radiation Oncology the Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer HospitalZhengzhou 450008China

Modern medicine is reliant on various medical imaging technologies for non-invasively observing patients’***,the interpretation of medical images can be highly subjective and dependent on the expertise of ***,some potentially useful quantitative information in medical images,especially that which is not visible to the naked eye,is often ignored during clinical *** contrast,radiomics performs high-throughput feature extraction from medical images,which enables quantitative analysis of medical images and prediction of various clinical *** have reported that radiomics exhibits promising performance in diagnosis and predicting treatment responses and prognosis,demonstrating its potential to be a non-invasive auxiliary tool for personalized ***,radiomics remains in a developmental phase as numerous technical challenges have yet to be solved,especially in feature engineering and statistical *** this review,we introduce the current utility of radiomics by summarizing research on its application in the diagnosis,prognosis,and prediction of treatment responses in patients with *** focus on machine learning approaches,for feature extraction and selection during feature engineering and for imbalanced datasets and multi-modality fusion during statistical ***,we introduce the stability,reproducibility,and interpretability of features,and the generalizability and interpretability of ***,we offer possible solutions to current challenges in radiomics research.

关键词： Artificial intelligence Radiomics Feature extraction Feature selection Modeling Interpretability Multimodalities Head and neck cancer

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Sleeve Gastrectomy with Duodenal Transit Bipartition (S-DTB): Preliminary Results and Technical Aspects of Its Metabolic Structure

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Surgical Science 2024年第4期15卷 244-264页

作者： Paulo Reis Esselin de Melo Ricardo Zorron victor Ramos Mussa Dib carlos Augusto Scussel Madalosso Rui Ribeiro Thonya cruz Braga Paula Volpe carlos Eduardo Domene Paulo Reis Institute Goiania GO Brazil Alfredo Nasser University center (UNIFAN) Goiania GO Brazil department of Bariatric and Metabolic Surgery CUF Descobertas Hospital Lisbon Portugal victor Dib Institute Manaus AM Brazil Gastrobese clinic Passo Fundo RS Brazil Lusiadas Amadora Hospital Lisbon Portugal clianest Group Renaissance Hospital Goiania GO Brazil Integrated center for Advanced Medicine (cIMAMED) Sao Paulo Brazil

Obesity is a significant and escalating health issue both in Brazil and globally, with over 650 million overweight adults worldwide. The treatment of obesity can be performed clinically, endoscopically or surgically;surgical treatment proves to be safe and more effective in terms of weight loss and long-term maintenance. Objective: This study aimed to monitor the progress of weight loss and comorbidity control in patients undergoing sleeve gastrectomy with duodenal bipartition. Methods: This pilot project involved 8 patients divided into 2 arms. In the first arm, patients underwent sleeve gastrectomy with Roux-en-Y duodenoileal transit bipartition (S-RYDITB), while in the second arm, patients underwent sleeve gastrectomy with Roux-en-Y duodenojejunal transit bipartition (S-RYDJTB). Both procedures involved Roux-en-Y reconstruction without duodenal exclusion. In S-RYDITB, the duodenal-ileal anastomosis was performed 300 cm from the ileocecal valve (IcV), creating a 250 cm common channel and a 50 cm alimentary channel. In S-RYDJTB, a biliopancreatic loop was created 200 cm from the angle of Treitz, with a 1 m alimentary channel. Results: Five patients underwent the procedures, with one undergoing S-RYDITB and four undergoing S-RYDJTB. No adverse events such as hospitalizations, readmissions, reoperations, fistulas, bleeding, pulmonary embolism, diarrhea, dumping syndrome, or hypoglycemia occurred during the study period. The mean length of hospital stay was 2 days. The average BMI decreased from 37.27 kg/m2 preoperatively to 29.48 kg/m2 after 6 months. The significant percentage of weight loss was 21.22%, with excess weight loss of 63.6%. Ninety-five percent remission of comorbidities, including hypercholesterolemia, hypertriglyceridemia, diabetes, hypertension, steatosis, and pre-diabetes. Two patients underwent sleeve gastrectomy with duodenal bipartition using a single anastomosis. conclusion: Duodenal switch surgery has gained worldwide recog

关键词： Obesity Bariatric Surgery Metabolic Surgery Duodenal Switch

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Responsiveness of functional performance and muscle strength,power,and size to resistance training:A systematic review

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Sports Medicine and Health Science 2024年第2期6卷 111-122页

作者： Tome Edson dos Reis Moda Ricardo Borges Viana Rayra Khalinka Neves Dias Eduardo Macedo Penna victor Silveira coswig Programa de Pos-graduaçaoem ciencias do Movimento Humano Universidade Federal do ParaCastanhalParaBrazil Instituto de Educaçao Físicae Esportes Universidade Federal do CearaFortalezaCearaBrazil

There is a recent and growing interest in assessing differential responders to resistance training(RT)for diverse ***,the individual ability to respond to an intervention for a specific measurement,called responsiveness,remains to be better ***,the current study aimed to summarize the available information about the effects of RT on functional performance and muscle strength,power,and size in healthy adults,through the prevalence rate in different responsiveness classifications models.A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA)and was registered at the International Prospective Register of Systematic Reviews(PROSPERO,cRD42021265378).PubMed/MEDLINE,Scopus,and Embase databases were systematically searched in October 2023.A total of 13 studies were included,totaling 921 *** two studies presented a low risk of *** the effectiveness of RT,the prevalence rate for non-responders ranged from 0%to 44%for muscle strength,from 0%to 84%for muscle size,and from 0%to 42%for functional performance,while for muscle power,the only study found showed a responsiveness rate of 37%.In conclusion,a wide range of differential responders is described for all variables ***,the evidence summarized in this systematic review suggested some caution while interpreting the findings,since the body of evidence found seems to be incipient,and widely heterogeneous in methodological and statistical aspects.

关键词： Strength training Heterogeneity Muscle strength Skeletal muscle Functional performance Inter-individual variation Biological individuality

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Review Integration of smartphone technology and artificial intelligence for advanced ophthalmic care:A systematic review

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Advances in Ophthalmology Practice and Research 2024年第3期4卷 120-127页

作者： Kai Jin Yingyu Li Hongkang Wu Yih chung Tham victor Koh Yitian Zhao Ryo Kawasaki Andrzej Grzybowski Juan Ye Eye center The Second Affiliated Hospital of Zhejiang University School of MedicineZhejiang Provincial Key Laboratory of OphthalmologyZhejiang Provincial Clinical Research Center for Eye DiseasesZhejiang Provincial Engineering Institute on Eye DiseasesHangzhouChina centre for Innovation and Precision Eye Health National University of SingaporeSingapore department of Ophthalmology National University of SingaporeSingapore Singapore Eye Research Institute Singapore National Eye CentreSingapore Ophthalmology and Visual Science Ac.demic clinical Program Duke-NUS Medical SchoolSingapore cixi Institute of Biomedical Engineering Ningbo Institute of Materials Technology and EngineeringChinese Academy of SciencesNingboChina Ningbo Eye Hospital NingboChina Zhejiang International Scientific and Technological cooperative Base of Biomedical Materials and Technology Ningbo Institute of Materials Technology and EngineeringChinese Academy of SciencesNingboChina Zhejiang Engineering Research center for Biomedical Materials Ningbo Institute of Materials Technology and EngineeringChinese Academy of SciencesNingboChina Division of Public Health Department of Social MedicineGraduate School of MedicineOsaka UniversityOsakaJapan Artificial Intelligence center for Medical Research and Application Osaka University HospitalOsakaJapan Institute for Research in Ophthalmology Foundation for Ophthalmology DevelopmentPoznanPoland A R T I C L

Background:The convergence of smartphone technology and artificial intelligence(AI)has revolutionized the landscape of ophthalmic care,offering unprec.dented opportunities for diagnosis,monitoring,and management of ocular ***,there is a lack of systematic studies on discussing the integration of smart-phone and AI in this *** text:This review includes 52 studies,and explores the integration of smartphones and AI in ophthalmology,delineating its collective impact on screening methodologies,disease detection,telemedicine initiatives,and patient *** collective findings from the curated studies indicate promising performance of the smartphone-based AI screening for various ocular diseases which encompass major retinal diseases,glaucoma,cataract,visual impairment in children and ocular surface ***,the utilization of smartphone-based imaging modalities,coupled with AI algorithms,is able to provide timely,efficient and cost-effective screening for ocular *** modality can also facilitate patient self-monitoring,remote patient monitoring and enhancing accessibility to eye care services,particularly in underserved *** involving data pri-vacy,algorithm validation,regulatory frameworks and issues of trust are still need to be ***,evaluation on real-world implementation is imperative as well,and real-world prospective studies are currently ***:Smartphone ocular imaging merged with AI enables earlier,precise diagnoses,personalized treat-ments,and enhanced service accessibility in eye *** is crucial to navigate ethical and data security challenges while responsibly leveraging these innovations,promising a potential revolution in care access and global eye health equity.

关键词： Artificial intelligence Smartphone imaging Ophthalmology Telemedicine Ocular disease management

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Post Episiotomy Morbidity among Parturient in Alex Ekwueme Federal University Teaching Hospital Abakaliki, Ebonyi State

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Open Journal of Obstetrics and Gynecology 2024年第8期14卷 1144-1160页

作者： John chinedu Obasi Ayodele Adegbite Olaleye Boniface N. Ejikeme John O. Egede charles Nwambeke Edene Enemma christian Enemma victor Onuchukwu Emmanuel Onyekelu Nathan c. Ekpe Wendy Oliobi Emmanuel c. Uwakwe department of Obstetrics and Gynaecology Alex Ekwueme Federal University Teaching Hospital AbakalikiNigeria

Background: Episiotomy is a very common obstetric surgery, and it could be associated with serious complications. However, these complications largely are not noticed due to the shift of attention from mother to baby, after a successful delivery. Objective: To identify the morbidities associated with episiotomies and factors associated with such morbidities. Method: This was a questionnaire based cross sectional descriptive study among women who attended the Obstetric.department of Alex Ekwueme Federal University Teaching Hospital Abakaliki Ebonyi State, between 1st July and 31st Nov, 2023. The study population consisted of parturients who had episiotomies in their previous confinements, attending either the antenatal clinic or the postnatal clinic at Alex Ekwueme Federal University Teaching Hospital Abakaliki Ebonyi State. Results: Macrosomia was the most common indication of episiotomy at a rate of 31.6%. The majority of episiotomies were performed on the parturients in their first confinement at a rate of 64.5% and the majority of repairs were performed by the Registrar at a rate of 65.0%. Informed consent was obtained from 45.79% of parturients while 54.21% were not informed before the episiotomy was administered. Only 55.3% of the parturient received analgesia before episiotomy was administered. The majority of the parturients had their episiotomy repaired between 10 - 15 minutes at a rate of 40.3%. Postoperative pain at the rate of 44.5% was the most common complication and dyspareunia as a form of sexual complication was the commonest at a rate of 31.3%. conclusion: The parturient needs to be properly counselled before administration of episiotomy and adequate analgesia should be given, as episiotomy is a surgical procedure. Proper training of health workers on both the technique of administering and repairing episiotomy is important. Restrictive use of routine episiotomy in primigravidae is advised to reduce the rate of episiotomy.

关键词： Episiotomy Vulva Pains Primigravidae Morbidities Analgesia

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